Bird by Bird, China Tackles Vast Flu Task

December 2, 2005
Copyright The New York TimesClick to see photos
By HOWARD W. FRENCH
LIDAYING VILLAGE, China – Five men on battered motorcycles pulled up at this roadside village from a nearby town and summoned the local headman.
Wearing ordinary clothes and bearing boxes of vaccine from two separate manufacturers, they worked their way from house to house, roughly 300 dwellings in all, to vaccinate every chicken, duck and goose in the hamlet against avian flu.
For the rest of the afternoon, the members of the small team took turns, some briefly explaining the process to the villagers into whose courtyards and homes they entered, others rounding up the fowl and others working their syringes, sticking the birds one by one. For the most part, they failed to take even the most basic hygienic precautions, like wearing surgical gloves or masks.
“We set out each morning at daylight, and we stop when we can’t see anymore,” said Shen Dianchun, a livestock extension worker whose work over 10 days in November had taken him up and down this tree-lined, two-lane country road that cuts through prime farmland in rural Anhui Province. Mr. Shen estimated that his team, one of thousands like it deployed recently, handled about 600 birds on a typical day. This vaccination by retail is part of a crash effort to inoculate the 14.2 billion domesticated fowl that constitute what the government estimates is the total bird population over a year’s time.
The mass vaccinations illustrate both the high priority China, the traditional incubator of flu pandemics, has placed on preventing the disease from leaping from birds to humans and the immense challenges involved, including the possibility that the rural health workers themselves might spread the virus, which can be acquired through contact with droppings or secretions from the birds.
China is also worried about its credibility, which was badly tarnished by the outbreaks of severe acute respiratory syndrome, or SARS, in 2003, which the authorities initially tried to cover up. But international experts say that Beijing’s official figure of only two human deaths from bird flu is suspiciously low, with some speculating that dozens or even hundreds may have died here already.
Since September, when the recent outbreak of avian flu was first acknowledged, Chinese authorities have ramped up production of bird flu vaccines at nine plants around the country, which are operating around the clock. Agriculture Ministry officials estimate that over 100 million doses are now being produced daily in the country, and teams like the one in this village are busy throughout the country, where life in close proximity to domesticated fowl is a common and ancient practice.
According to Chinese news reports, and interviews with people involved in the inoculation effort in several different parts of the country, the vaccination drive is proceeding relatively well in places that have large poultry industries. In the countryside, however, among China’s peasantry, vaccine is reportedly in short supply, despite the huge production.
Typically, the extension workers who are carrying out the vaccination campaign have little epidemiological training and, like the ones in this village, take virtually no precautions, even to protect themselves against exposure to the disease.
One of the extension workers, who wore no gloves, face mask or any other protection, climbed inside a coop containing a dozen or so chickens and handed the birds out one by one to two of his co-workers. One of them held the birds while the other swabbed them and applied the needle.
Zhang Rongting, an elderly woman who owned the house, then placed the birds in straw crates, covering them with washbowls to calm them and isolate them until the job was complete. Asked what kind of shots her chickens were getting, she said, “You guys know, we don’t.”
Toward the end of the afternoon, when the presence of foreigners in the village drew the attention of local officials, the vaccination team donned white smocks for the first time, but continued to handle the birds bare-handed and without masks. After inoculating the geese in one dusty courtyard, the team discarded its used needle on the ground and walked away.
Problems have cropped up on the regional and national levels as well. In a country that is awash in black market and counterfeit goods, there have been confirmed reports of illicit vaccines circulating, leading some specialists to speculate that these ineffective vaccines have played a role in the transmission of the disease among birds. And local officials say they are having trouble getting enough vaccine. “The problem here is a tight supply of vaccines, so we’ve first done the big breeders, not the individual families,” said Jiang Chenggang, an official in the veterinary bureau of Yingshang County, in northwestern Anhui Province.
“Yingshang has 4 million domesticated birds, maybe 700,000 of which have been vaccinated. If the supply were sufficient, we would probably be able to finish this in three to four days.”
An official in Changfeng, another nearby county, said much the same, complaining that the provincial capital, Hefei, had been unable to furnish adequate supplies of the vaccine. “If we apply for 500,000 birds, they’ll give us enough for 200,000,” he said.
“Others need to wait for several days. It’s not just Hefei that is short of vaccines, the whole of Anhui Province is.”
Even assuming sufficient supplies and everything working perfectly, the scale of China’s campaign is unprecedented, and perhaps unsustainable, too. Considering the need for biannual vaccinations, then adding to that the country’s sheer immensity and the size of its population – typically put at 1.3 billion, but in fact unknown with any precision – the flavor of the challenge becomes clearer.
The country is estimated to have 640,000 to a million villages where fowl are raised in close proximity with humans, making any effort to sustain a biannual vaccination campaign something akin to fielding an army of extension workers, veterinarians, doctors and other public health experts.
Even an army may not be enough, people here say, if its manpower and equipment are not equal to the task. “Our biggest problem is poverty,” said Yan Yi, an accountant with the nearby Xiaqiao township’s government, who worked on the village vaccination team. “The extension workers are too tired, and the vaccines are insufficient. The whole town has received only 50 bottles for 60,000 to 70,000 birds.” Mr. Yan said the vaccine received met less than half of their needs.
As the team entered the courtyard of another home in the village a man approached it holding two big chickens, saying he had owned five but killed three, so he could eat them while they were still safe. “The chickens are beautiful,” the peasant said, admiring his birds as they received their shots.
With the sun beginning to set, the weary team still had one more house to cover. One man complained that he was too tired even to eat dinner that night, and could not flex his wrist after holding the birds all day.
“Birds can pass the disease to humans, but there has been no human-to-human case reported so far,” he said, when asked whether their effort had done any good. “It can be prevented if the birds are vaccinated.”
“We’re in the front line, and we’re not afraid because we do this every day.”